Tendonitis

Fig 1. This shows the anatomy of the shoulder joint, including the rotator cuff and shoulder blade (acromion). The rotator cuff consists of four muscles: subscapularis, supraspinatus, infraspinatus and teres minor muscles. These muscles end in tendons that comprise the tendons of the rotator cuff.

640px-2018-10-11_Snatch_(Weightlifting_Girls'_58kg)_at_2018_Summer_Youth_Olympics_by_Sandr

640px-Kazan_2015_-_Katie_Ledecky_swims_to_1500m_gold.jpg

Shoulder Anatomy

Shoulder tendonitis is a condition where the tendons of the shoulder are inflamed (either the rotator cuff or biceps tendon).

Tendons are tissues that connect muscle to bone. The rotator cuff consists of four tendons in the shoulder that help stabilize, lift, and rotate the arm: the subscapularis, supraspinatus, infraspinatus and teres minor. The biceps tendon connects the biceps muscle to the bones of the shoulder. It has two “heads” that connect to different bones of the shoulder. The biceps tendon long head connects to the glenoid (the socket of the shoulder) and goes through a very narrow space to do so. This can lead to the irritation and inflammation of the tendon.

Who Gets It?

Anything that causes the tendons of the shoulder to be pinched by surrounding structures can lead to shoulder tendonitis, from years of overhead activity to acute injuries. Years of overhead sports and jobs, or just doing a new repetitive overhead movement can cause this condition. It can also be caused by impingement syndrome, which occurs when the rotator cuff rubs against the bones of the shoulder and becomes inflamed.

What does it feel like?

Common symptoms of tendonitis include pain, stiffness, and swelling. If you have this condition, you may also experience a limited range of motion, tenderness, and night pains. These symptoms are similar to bursitis, which is another inflammatory condition.

How is it diagnosed? And what are the complications?

To diagnose these different inflammatory conditions that affect the joints, a medical history and physical examination will be performed. A physician can assess your pain and range of motion to rule out arthritis or other joint problems, as well as examine for swelling, redness, warmth. Tissue may be extracted from swollen bursa to check for gout or infection, while blood tests and imaging (X-Ray/MRI) may be taken to check for other conditions. A variety of conditions can factor into tendonitis, including subacromial impingement, rheumatoid arthritis, diabetes, and gout, making the diagnosis complex.

If untreated, tendonitis can develop into more serious conditions. It can increase the risk of tendon rupture, and if it continues for months it can lead to tenodesis, which is the chronic degeneration of the tendon. So, diagnosing the cause of shoulder pain can be important to preventing further issues.

Treatment

The initial treatment for shoulder tendonitis includes, rest, ice, compression, over the counter pain medications like Tylenol and Ibuprofen, physical therapy, ultrasound therapy (biceps tendonitis), and activity modification. If these are unsuccessful, a cortisone injection or surgery is considered. The surgery performed on rotator cuff tendonitis is arthroscopy, or open surgery in more severe cases. The surgical options for bicipital tendonitis include repair, biceps tenodesis (damaged part of tendon is removed and remaining part is attached to the humorous), and tenotomy. Bicipital tendonitis can be surgically treated via arthroscopic or open surgery. Tenotomy is reserved for severe cases, and is performed by releasing the biceps tendon from its attachment site.

Prevention

Shoulder tendonitis is often caused by overuse. To prevent this condition, either avoid or modify overhead activities, and stop if there is abnormal pain. For example, Wheel heavy loads, and take lots of breaks during activities involving heavy lifting. Stretching before and having good technique during overhead activities can also help prevent tendonitis.

References

Attributions for Images

1. OpenStax College. “Shoulder Joint”. Wikimedia Commons, 19 May 2013, https://commons.wikimedia.org/wiki/File:914_Shoulder_Joint.jpg.

2. Edwin Martinez. “Serena Williams”. Wikimedia Commons, 29 August 2013, https://commons.wikimedia.org/wiki/File:Serena_Williams_(9630796711).jpg.

3. Sandro Halank. “2018-10-11 Snatch (Weightlifting Girls' 58kg) at 2018 Summer Youth Olympics by Sandro Halank”. Wikimedia Commons, 11 October 2018, https://commons.wikimedia.org/wiki/File:2018-10-11_Snatch_(Weightlifting_Girls%27_58kg)_at_2018_Summer_Youth_Olympics_by_Sandro_Halank%E2%80%93118.jpg.

4. Keith Allison. “Stephen Curry”. Wikimedia Commons, 3 February 2016, https://commons.wikimedia.org/wiki/File:Stephen_Curry_(24178934184).jpg.

5. Oleg Bkhambri. "Kazan 2015 - Katie Ledecky swims to 1500m gold.JPG". Wikimedia Commons, August 4, 2015, https://commons.wikimedia.org/wiki/File:Kazan_2015_-_Katie_Ledecky_swims_to_1500m_gold.JPG.

6. Erik van Leeuwen. "Bregje Crolla during Europacup 2007". Wikimedia Commons, June 23, 2007, https://commons.wikimedia.org/wiki/File:Bregje_crolla_Europacup_2007.jpg.

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